Images in CAD 459
Images in CAD Coronary Artery Disease 2015, 26:459–460
Progression of cardiac allograft vasculopathy detected by optical coherence tomography Ryotaro Yamadaa, Kiyoshi Yoshidab and Hiroyuki Okuraa, aDepartment of Cardiology, Kawasaki Medical School, Kurashiki and bDepartment of Cardiology, Sakakibara Heart Institute of Okayama, Okayama, Japan Correspondence to Hiroyuki Okura, MD, Department of Cardiology, Kawasaki Medical School, 577 Matsushima Kurashiki 701-0192, Japan Tel: + 81 86 462 1111; fax: + 81 86 464 1069; e-mail: [email protected] Received 14 January 2015 Revised 16 January 2015 Accepted 23 January 2015
A man in his 40s who underwent heart transplantation 17 years ago because of dilated cardiomyopathy was admitted to our hospital because of dyspnea. He was well until 3 months earlier, when he underwent annual cardiac catheterization including coronary angiography (CAG), intracoronary optical coherence tomography (OCT) imaging, and right ventricular (RV) biopsy. CAG showed no significant stenosis (Fig. 1a and b) and RV biopsy did not show evidence of rejection. OCT indicated minimal amount of neointimal thickening with a low signal
Fig. 1
Serial coronary angiography and optical coherence tomography (OCT) for evaluation of progression of cardiac allograft vasculopathy. Coronary angiography showed no significant stenosis (a, b). OCT indicated a minimal amount of neointimal thickening with a low signal intensity in his left circumflex coronary artery (e) that was not observed 3 months ago (d). Three months later, coronary angiography showed diffuse luminal narrowing (c). OCT showed a large amount of neointimal thickening with a low signal intensity (f). Red triangles indicate where OCT was analyzed.
0954-6928 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
DOI: 10.1097/MCA.0000000000000234
Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.
460
Coronary Artery Disease 2015, Vol 26 No 5
intensity in his left circumflex coronary artery (Fig. 1e) that was not observed 3 months ago (Fig. 1d). Three months later, he was readmitted to our hospital because of dyspnea. Although RV biopsy was negative for rejection, CAG showed diffuse luminal narrowing of the left circumflex coronary artery (Fig. 1c). OCT showed a large amount of neointimal thickening with a low signal intensity (Fig. 1f). Cardiac allograft vasculopathy (CAV) is the main cause of graft failure and death in heart transplant recipients surviving more than 1 year after transplantation [1]. Despite the advances in surgical techniques and immunosuppression therapy, CAV remains one of the major factors limiting long-term survival. The early diagnosis of CAV is difficult because of the lack of early clinical signs and symptoms. CAG is performed as a standard screening test for the detection of CAV. However, CAG provides only luminal dimensions and thus may not reveal pathological changes in the vessel wall. Intravascular ultrasound has
been used as an additional intravascular imaging modality to detect pathological intimal thickening of the coronary arterial wall in patients with CAV. Recently, OCT has been introduced as a novel intracoronary imaging technique, which has a far better resolution than intravascular ultrasound [2]. Our present case may suggest that OCT detects very early coronary arterial changes because of CAV.
Acknowledgements Conflicts of interest
There are no conflicts of interest.
References 1
2
Taylor DO, Stehlik J, Edwards LB, Aurora P, Christie JD, Dobbels F, et al. Registry of the International Society for Heart and Lung Transplantation: Twenty-sixth Official Adult Heart Transplant Report. J Heart Lung Transplant 2009; 28:1007–1022. Hou J, Lv H, Jia H, Zhang S, Xing L, Liu H, et al. OCT assessment of allograft vasculopathy in heart transplant recipients. JACC Cardiovasc Imaging 2012; 5:662–663.
Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.
Images in CAD Coronary Artery Disease 2015, 26:459–460
Progression of cardiac allograft vasculopathy detected by optical coherence tomography Ryotaro Yamadaa, Kiyoshi Yoshidab and Hiroyuki Okuraa, aDepartment of Cardiology, Kawasaki Medical School, Kurashiki and bDepartment of Cardiology, Sakakibara Heart Institute of Okayama, Okayama, Japan Correspondence to Hiroyuki Okura, MD, Department of Cardiology, Kawasaki Medical School, 577 Matsushima Kurashiki 701-0192, Japan Tel: + 81 86 462 1111; fax: + 81 86 464 1069; e-mail: [email protected] Received 14 January 2015 Revised 16 January 2015 Accepted 23 January 2015
A man in his 40s who underwent heart transplantation 17 years ago because of dilated cardiomyopathy was admitted to our hospital because of dyspnea. He was well until 3 months earlier, when he underwent annual cardiac catheterization including coronary angiography (CAG), intracoronary optical coherence tomography (OCT) imaging, and right ventricular (RV) biopsy. CAG showed no significant stenosis (Fig. 1a and b) and RV biopsy did not show evidence of rejection. OCT indicated minimal amount of neointimal thickening with a low signal
Fig. 1
Serial coronary angiography and optical coherence tomography (OCT) for evaluation of progression of cardiac allograft vasculopathy. Coronary angiography showed no significant stenosis (a, b). OCT indicated a minimal amount of neointimal thickening with a low signal intensity in his left circumflex coronary artery (e) that was not observed 3 months ago (d). Three months later, coronary angiography showed diffuse luminal narrowing (c). OCT showed a large amount of neointimal thickening with a low signal intensity (f). Red triangles indicate where OCT was analyzed.
0954-6928 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
DOI: 10.1097/MCA.0000000000000234
Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.
460
Coronary Artery Disease 2015, Vol 26 No 5
intensity in his left circumflex coronary artery (Fig. 1e) that was not observed 3 months ago (Fig. 1d). Three months later, he was readmitted to our hospital because of dyspnea. Although RV biopsy was negative for rejection, CAG showed diffuse luminal narrowing of the left circumflex coronary artery (Fig. 1c). OCT showed a large amount of neointimal thickening with a low signal intensity (Fig. 1f). Cardiac allograft vasculopathy (CAV) is the main cause of graft failure and death in heart transplant recipients surviving more than 1 year after transplantation [1]. Despite the advances in surgical techniques and immunosuppression therapy, CAV remains one of the major factors limiting long-term survival. The early diagnosis of CAV is difficult because of the lack of early clinical signs and symptoms. CAG is performed as a standard screening test for the detection of CAV. However, CAG provides only luminal dimensions and thus may not reveal pathological changes in the vessel wall. Intravascular ultrasound has
been used as an additional intravascular imaging modality to detect pathological intimal thickening of the coronary arterial wall in patients with CAV. Recently, OCT has been introduced as a novel intracoronary imaging technique, which has a far better resolution than intravascular ultrasound [2]. Our present case may suggest that OCT detects very early coronary arterial changes because of CAV.
Acknowledgements Conflicts of interest
There are no conflicts of interest.
References 1
2
Taylor DO, Stehlik J, Edwards LB, Aurora P, Christie JD, Dobbels F, et al. Registry of the International Society for Heart and Lung Transplantation: Twenty-sixth Official Adult Heart Transplant Report. J Heart Lung Transplant 2009; 28:1007–1022. Hou J, Lv H, Jia H, Zhang S, Xing L, Liu H, et al. OCT assessment of allograft vasculopathy in heart transplant recipients. JACC Cardiovasc Imaging 2012; 5:662–663.
Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.
